Permit CITY OF TIGARD MECHANICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit #: MEC2012 00171
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/05/2012
Parcel: 1S134DC10300
Jurisdiction: Tigard
Site address: 11496 SW CORNELL PL
Project: Bowker Subdivision: TIGARD PARK Lot: 19
Project Description: Installation of gas line to barbecue.
Contractor: COLUMBIA HEATING & COOLING INC Owner: BOWKER, LEANNE MARIE
PO BOX 230397 11496 SW CORNELL PL
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 293 -0075
FAX: 503 - 598 -0270
•
• FEES
Specifics: Description Date Amount
Fuel Piping 04 /05/2012 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 04/05/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /05/2012 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct qu ns UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By. Permittee Signat
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
•
Approved plans are required on the job site at the time of each inspection.
Apr 03 12 04:41 p Columbia Heating /Cooling 503 - 598 -0270 p.2
RECEIVE.P
OFhIi ELSEO \L}
Mechanical Permit Application FOR
City of Tigard APR 3 2012 cr�s� 3 /a y, , Permit No.: eeA /Z _ OD/7/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review p Permit 503.718.2439 Far 503.598.1960 e3 " -'
a re or r� Plan
>.
"r 1 c IL D Ins ration Lille: 503.639.4175 BIN, I , - ' i kris 10 See Page 2 for
P f1 t Note RciMetho d: 1 Suppkwenrat Information
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. . AL TEE" SC7iEDLLE - laSE CHECKLIST
COMIV/ERCI
: 4'YgE :.OF:. 4 R K ,:: ` " : . _ Meehanioal permit fees' arc based on the value of the work
O New construction A. Addition 'tdterationirepiacemextt performed. indicate the value (rounded to the nearest dollar) of all
❑ fk mot itinn ❑ Other: mechanical materials, equipment, labor. overhead, and profit.
Value: $
-.. RFSIAEN17r►L II;QUIPA1EKT! SYSTEMS F • •
W I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building tar spedalInformation use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. } Ea ! Total
Beating/cooling:
• • ' 308 STiE;1NYORMATI LOCK.110 .. ` Air conditioning
t T team s placement) 46.75
Job site address: ' i i � Sj S I a � � ` (requires site plan s
Furnace 100.000 BTU Noon+vents) _ 46.75
City/Stale/ZIP:
E �� j/ r � Furnace loo.onw' Bill (duetdoCmmra) 53.91
Suite/bld Ja L no.: 1 Heat pump
E P ' � � IL . - ♦ ncq.irc site plan stewing placement', 1 61.06
Cross street/directions to job site: Duel work 23.32 • A
4 I fvdronic hot mater system _ 23.32
Re boiler (radiator or
hydronic) + 23.32 1
Unit ]sealers (fuel -type. not electric).
in -wall. in -duct, suspended. etc. 46.75
Lot nu : Flueivent for any of above 23.32
Subdivision: Other. 2332
Tax map/parcel no.: I Other fuel appliances:
: - _ : : : : : d �� Water heater
N r Gas fireplace 33.39
Flue veal( for water hatter or €a5
tircplaex. 23.32
Loa lighter (gas) 1 23.32 _
Wood /pellet stove 33.39 .
Wand fireplace/insert , 23.32
23.3
Cbimnerllirur /flue/vent 23.32
N6$t : ..:.: ,:::. 7EnAi� f 2
... OlOther P3it+DP ... ,
Name: �� .M� M Q A 1' :nrirvwmennal exhaust and ventilndu _ _
�J V � ' /�/� Range acwdlotlrr kitchen
Address: I ` (p CI 1 ere71000 Clothes dryer 33.39
I exhaust 33.39
City /State ZlP: i j e � � �
Sin
11 (bathrooms.
Phone: 5S) ! 015 Fax: ( ) toilet compartments, utility rooms) 23.32
. _ cratr sp a tans 2 . 32
. Attid 1 a<: ' �3
- �. : COIYYACC FERSON , 23.32
- ' Other
Business name Columbia Heating and Coo&ag, Inc
Fuel piping:
Contact name: Marleaa vleednm 514.15 far first four. 54.03 for each additional
-- —
Address: PO Box 230397 Furnace, etc. '
Gas htmtpump -
City /State/ZIP: 97281 Wall/suspended/tulit heater
Phone: (503) 624 I Fax: : (503) 598 - 0270 i [Pater heater ,
j Firsslacc
E-mail: colomb6e@teicporl.com
1 /
. (business name: Columbia Pleating and Cooling, i.. C t es (layer (pas)
t ' Other. _
Addr PO Bos 230397 - .. : • • .. . aA7Yl,C-4L • tigc PER.rHII FEES!
City /State/ZIP: Tigard, OR 97281 I Subtotal
Minimum permit fee (090.00) 4 :0 .
Phone: (303) 624 -2704 I Fax (503) 598 -0270 _ Plan review (25% of permit fee) -----
CCB tic.: 76359 State surcharge 112% of permit fee) O. :0
J if n permit is nut obtained within 180
TOTAL PERMIT FEE Ira :- _
�� /' . �l This permit application expires
Authorized si�tatlae: Ill(` days a fter it has teen accented as complete.
l Print name: Marietta R Meedom Dale: 44... 3...1--e. J ' fee incnhodotugy net by Tli•Ctwoty Bui ding WdtotryScniec Band
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